Shyr Bor-Shiuan, Wang Shin-E, Chen Shih-Chin, Shyr Yi-Ming, Shyr Bor-Uei
Division of General Surgery, Department of Surgery and Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei Veterans General Hospital, National Yang Ming University, 201 Section 2 Shipai Road, Taipei, 112, Taiwan, ROC.
National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Surg Endosc. 2025 Feb;39(2):1191-1199. doi: 10.1007/s00464-024-11475-6. Epub 2024 Dec 29.
Mesopancreas dissection (MPD) level 3 in combined robotic/open pancreatoduodenectomy (CR/OPD) is technique-demanding. This study aims to clarify the feasibility and justification of MPD level 3.
Propensity score matching (PSM) analysis was conducted for 208 patients with pancreatic head cancer undergoing CR/OPD with or without MPD level 3. The comparison focused on surgical and oncological outcomes.
After PSM, each group comprised 86 patients. Surgical outcomes were comparable between these two groups, except longer operation time for MPD level 3 (+), median: 10.5 vs. 9.5 h, p = 0.002. MPD level 3 (+) group exhibited higher lymph node yield, median: 20 vs. 17, p < 0.001, and curative (R0) resection rate, 89.5% vs. 69.8%, p = 0.001, compared to MPD level 3 (-) group. Among the entire cohort, no significant survival difference was observed between the MPD Level 3 (+) and (-) groups. Survival outcome for R0 resection after CR/OPD was notably better than those for R2 resection, 5-year survival: 34.0% vs. 0, p = 0.038. However, within the curative (R0) resection cohort, no survival difference was observed between the MPD level 3 (+) and MPD level 3 (-) groups.
MPD level 3 in CR/OPD is technically feasible without increasing the surgical risks but takes one hour extra operating time. Incorporation of MPD level 3 does not confer a survival advantage within the curative (R0) resection cohort. The primary focus should continue to be on achieving curative (R0) resection to maximize the survival benefits for pancreatic head cancer.
在机器人辅助/开放联合胰十二指肠切除术（CR/OPD）中，中胰切除术（MPD）3级操作难度较大。本研究旨在阐明MPD 3级的可行性和合理性。
对208例接受CR/OPD且有或无MPD 3级的胰头癌患者进行倾向评分匹配（PSM）分析。比较重点为手术和肿瘤学结局。
PSM后，每组各有86例患者。两组的手术结局具有可比性，但MPD 3级（+）组的手术时间更长，中位数分别为：10.5小时对9.5小时，p = 0.002。与MPD 3级（-）组相比，MPD 3级（+）组的淋巴结清扫数量更多，中位数分别为：20个对17个，p < 0.001，且根治性（R0）切除率更高，分别为89.5%对69.8%，p = 0.001。在整个队列中，MPD 3级（+）组和（-）组之间未观察到显著的生存差异。CR/OPD术后R0切除的生存结局明显优于R2切除，5年生存率分别为：34.0%对0，p = 0.038。然而，在根治性（R0）切除队列中，MPD 3级（+）组和MPD 3级（-）组之间未观察到生存差异。
CR/OPD中的MPD 3级在技术上是可行的，且不增加手术风险，但手术时间会额外增加1小时。在根治性（R0）切除队列中，纳入MPD 3级并不能带来生存优势。首要重点应继续放在实现根治性（R0）切除上，以最大化胰头癌患者的生存获益。
